RECENTLY, there has been a debate on whether it is too early to open up the borders, in light of the increasing number of daily cases recorded.

Closed borders will affect the economy, especially the supply chain industry and may strike a fatal blow to the tourism and aviation industries, which are huge revenue earners for any economy.

Taking into account that statistics in many countries show transmission of the virus via imported cases is relatively lower than community (local) transmission, there is a case for opening up the border.

The danger is always the unsuspecting foreigners coming to our country as tourists, businessmen, government officials, exhibition and conference goers may be infected when they reach our shores.

From there, they can spread the virus through community transmission. Imported cases also refer to locals returning from abroad.

Hence, while daily cases are on the rise and constitute a threat to the situation, opening of the borders must be done gradually and with some restrictions.

It is indeed not the time to do away with mandatory quarantine. Even when the virus becomes endemic is reached, mandatory quarantine is always a must for positive cases.

What can be done is gradually to remove quarantine by first reducing its duration. Quarantine used to be two weeks at the start of the pandemic.

Now it is five days for asymptomatic close contacts with booster jab, seven days for asymptomatic close contacts that are fully vaccinated and 10 days for the asymptomatic, unvaccinated close contacts.

This can be reduced further to three days, five days and seven days respectively once the threat of a rising daily cases has subsided.

During the early days of the pandemic, if you were positive, you had to be quarantined for 14 days.

Now, it’s seven days if you’re fully vaccinated and asymptomatic, and 10 days if you’re not fully vaccinated or unvaccinated and you’re symptomatic.

Moreover, even if you’re positive but as long as you’re asymptomatic (Category 1) or exhibit mild symptoms (Category 2A) and are not in the high-risk category (ie below 60 years old and have no comorbidity), you’re allowed to be quarantined at home.

A day will come when these quarantine periods should be reduced further to fewer days than it is now, and a truly endemic stage will see all mandatory quarantine will be a home-based one that are limited to the positive cases only.

Malaysia is moving towards this. On February 24, Health Minister Khairy Jamaluddin announced individuals above the age of 18 who have taken their booster jab will no longer be required to be subject to a home surveillance order if they don’t show any symptoms of the virus after coming into close contact with a Covid-19 positive case. This will take effect on March 1.

Also due to the fact that imported cases are relatively lower than cases via community transmission, we can start now by allowing everyone visiting the country not to be subjected to mandatory or home quarantine if they test negative upon arrival.

All these moves to reduce quarantine and make it easier to do so at home are to be seen as the process towards the endemic stage.

When this is reached, even close contacts should not be quarantined for so long as they are negative and don’t show any symptoms.

For a country that has not reached the endemic stage but is in the process of moving towards it, whenever the caseloads in hospitals become more manageable, restrictions may be eased.

This of course means cases will go up again, and then restrictions will have to be re-imposed again.

Thus, depending on the surge of each wave, restrictions may be eased or re-imposed.

This is not a flip-flop. Neither does this mean the government and policymakers in Malaysia are clueless when you see this surge of cases.

They are persevering towards the endemic stage to ensure the healthcare system remains intact to take care of you.

Hence, moving forwards is not going to be a pretty sight.

Proponents of living with the virus need to specify quantitatively the parameters that constitute the endemic stage so that it is very clear to all what it means.

The first parameter is quite easy to specify ie, capacity of the public healthcare system based on the bed utilisation rate in intensive care unit (ICU) wards.

This is necessary because the stage must be associated with infections that will not paralyse the healthcare system.

Hence, a warning system should be developed to let all especially frontliners know whether at any point in time the healthcare system can cope with the number of daily infections.

For example, the use of colour coding where green denotes bed utilisation rate in ICUs of below 50%, orange denoting a utilisation rate of 50% to 80%, while yellow is a rate of between 80% to 100%, and finally red, above 100%.

As long as this rate is in the green or orange, the situation is endemic because the hospital can cope with the rising infection.

The first sign of danger is yellow when the rate is 80% to 100%, which means this is the time where private hospitals need to be roped in to increase the capacity of the healthcare system before it gets overwhelmed.

Once the bed utilisation rate is 100%, then the army would have to be roped in to set up more field hospitals.

Taking care of the healthcare system’s ability to absorb new infections means the endemic stage is sustainable.

The next parameter is the number of deaths. Proponents say that we can really move quickly towards a true endemic stage in as short a time as possible by removing all restrictions, and open all borders.

However, they do admit this will lead to a surge of infections so high that the healthcare system cannot cope, and people will die for lack of oxygen supplementation because there is no room for them.

It is thus the human cost because all lives matter, which has prevented proponents from implementing this superfast approach.

Yet what does ‘all lives matter’ mean when obviously we know that the infections will cause some deaths?

What are the mortality figures that we can live with during the endemic stage? One way to arrive at a proxy number is to compare it with other endemic viruses like the common cold.

From the average figures of deaths per day/week/month/year caused by the common cold in the past 10 years, we can then use this average proxy figure to denote the number of deaths that’s consistent with an endemic virus.

Finally, specifying quantitatively the parameter of daily cases “when the virus is circulating among us without being the threat that it is now”. This is very difficult to determine.

In the past, when the daily infection figures were consistently in the three digits, this was considered as threatening enough to merit a movement control order (MCO) such as the first ever MCO implemented in March 2020.

The last time we had a three-digit daily infection was in September 2020 after the Sabah elections.

Now, if we ever reach a three digit daily infection, I’m sure all of us will heave a sigh of the greatest relief because we no longer consider it a threat.

So, what this means is the daily infection number consistent with the endemic stage is a moving number like a moving average, depending very much on the surge of each wave.

For now, that number could be below 5,000 cases a day because, before we experienced the current five-digit surge, the daily infection numbers were hovering just below 5,000 cases for quite a long time, accompanied by the feeling that things are quite normal as if we are already in an endemic phase. – March 1, 2022.

* Jamari Mohtar is the Editor of Let’s Talk!, an e-newsletter on current affairs.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.